TrinityMag Global Services

TRINITYMAG GLOBAL SERVICES MEDICAL BILLING SERVICES

BREAKING BARRIERS IN BPO THROUGH INNOVATIONS

TGS PMB
Welcome to TGS Professional Medical Billing
TGS is a full service billing center specializing in electronic filing of insurance claims, patient balance billing, and collection of old receivables. Located in New Delhi. Core Services These services represent the bulk of our daily tasks and are the ones that provide you with your cash flow. They encompass everything needed to completely bill a claim; from the initial superbill to getting your payments posted. Practice Management These services are comprised mainly of the reporting that is generated from the Core Services. They allow you to optimize your collections and ultimately increase your cash flow.

TGS Medical Billing Services

Medical Transcription Scheduling Coding Fee Schedule Credentialing of Providers Demographic & Super Bill Entry Transmission of Electronic & Paper Claims Payment Posting Denials Management AR follow-up on unpaid claims Follow up Electronic Claims(10 days), Paper Claims(30 days) Appeal on low payment Patient Bills Weekly Reports Top 10 carriers) Monthly Reports Financial Report)

Why Outsource to TGS

Have You Considered Outsourcing your Medical Billing to TGS Experts?
Outsourcing your medical billing claims can be very profitable for Physicians because it eliminates all the daily expenses associated with Keeping medical billing In-House. It is Aceteras responsibility to relinquish these expenses from your practice enabling you to receive greater profitability.

What Are Some Of The Benefits Of Outsourcing

The Expertise Our Execution Strategy People Power

Shortened insurance payment cycles of 10-14 days Increased cash flow Reduced outstanding accounts receivable Customized reports analyzing your practice Patient Account Management by a highly qualified professional No need to invest thousands into a new system No need to train your staff on a new and sometimes complicated system You save money and time! Access your patient account information via your own computer

Set Strategic Goal

Condition for Performance Gap

Collect Performance Data

Quality In TGS
Communicate Results Collect Ongoing Performance Data

Hourly , Daily Weekly Performance Cycle

Generate Competence / Performance Gap Track Results

Set Performance Target

Analyze Performance

Develop Key Performance Indicator

INDUSTRY BENCH MARKS

Account Receivables Days > 60 Days Total Account Receivables - -> 2.5 times of monthly Charges Collections - -> 40% of monthly Charges

TGS Forging Ahead

Pre-Analysis Key Activities client business needs Identify outsource opportunities Assess requirements Review environment Confirm viability Location Timeline Responsibility
Client functional managers Acetera Functional specialists Client Acetera Understand Gather documentation Identify solution and Adapt process plan Emulate client process Confirm performance Operations

Analysis

Transition Management

Ongoing Operations

accepts

costing Confirm and validate with client Prepare process implementation plan

requirements Customer acceptance

service responsibility Quality plan put into effect SLA acceptance

Offshore 2 weeks

Offshore 2 weeks

Offshore 3-4 weeks

Offshore Ongoing engagement

Client

functional managers analysis team

Client functional managers Acetera transition team

operations team Acetera service delivery head

CAPABILITIES
TGS has experience of 5 plus years in the Front Office / Back Office Medical Billing / Practice Management Industry. The staff at TGS have worked with most of the states along the eastern as well as the western coast of the US. Keeping abreast of the changes in guidelines for billing various carriers through participation in Medical Billing Forums, subscribing to Manuals and Bulletins from Insurance Companies. TGS has a comprehensive training schedule for both experienced as well as fresh candidates. We always maintain a bench strength so that the day to day routine of the clients do not suffer at any point.

SKILL SETS
Specialties Radiation Therapy Ambulatory Surgical Centre Pathology Family Practice Gastroenterology General Surgery Gynaecology Infectious Disease Cardiology Oncology & Hematology Medic (Misys PM / Tiger) Medical Manager PMC Geysers NextGen Obstetrics Orthopaedics ENT Pediatrics Podiatry Psychiatry Radiology Internal Medicine Neurology Physical Therapy Software EMDS Medplexus Lytec Kareo Excalibur Medisoft SequelMed Vericle

EXPERIENCE
We have staff who have physical hands on offsite experience of working with group practices in various states for more than 5 years. We have worked with group practices in Family Practice, Internal Medicine clients in the State of Maryland. We have onsite experience in the following domains Scheduling of Appointments Front Office All the processes in Medical Coding / Billing Liaisoning with Software Companies Data Migration from one software to another

Modules in Medical Billing

Flow chart of Medical Billing Process of Medical Billing Scanning Department Coding dept Patient Demographics Superbill / Charge dept Quality dept Transmission dept Payment posting dept Insurance Follow up / Analysis Patient Analysis Month End Reports

FLOW CHART OF MEDICAL BILLING

PROCESS - MEDICAL BILLING

CLIENT IN US SCANNING TO INDIA CODING ACCESSSING SOFTWARE PATIENT DEMOGRAPHICS ENTRY CHARGE ENTRY QUALITY AUDIT

Paid Claims for TRANSMISSION OF CLAIMS THRU CLEARINGHOUSES cash application

Unpaid Claims For corrective action

CASH APPLICATION

AR ANALYSIS / CALLING

CASH TALLYING

ACTION ON DENIALS / REJECTIONS

MIS / GENERATION OF REPORTS

REPORTS TO CLIENT

SCANNING DOCUMENTS TO INDIA

US Office scans Patient Demographics, Charge Sheets, Insurance Card Copies, etc.

Scanned copies would be saved as *.TIF (Tagged Image Format) file and placed in FTP Site

In the FTP Site, Files would be placed in the common path which can be accessible by India

Mail to India on Scan date, File name and directory path.

MEDICAL CODING
Log to be maintained with File name, Total charges, Specialty details, etc before Coding.

Coding of Diagnosis to the utmost specificity using ICD-9 CM Manual.

Coding of Procedures by referring to CPT / HCPCS / ASI Manuals

After Coding, files to be handed over to Charges Department for processing.

PATIENT DEMOGRAPHICS
Documents to be sorted Patient wise before entering into the system

Patient Account Numbering to be done, if system does not generate automatically

Patient #, Name(LFM), Address, SSN, Sex, Employer, Home Ph, Work Ph, Guarantor, Marital Status, Subscriber details, Doctor#, Insurance information etc to be entered in the system

If any clarification is required, send mail to US office

After entering, printouts to be taken and data to be checked

Log to be maintained with Total Patients, Patients entered, Pending details, etc.

CHARGE ENTRY
Patient Demographics and Coding to be done before entering Charges Charge File to be sorted by Patient / Date of Service Patient #, Doctor # , Place of Service, Type of Service, Date of Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, Referral , Prior Authorization, On Bill comments, etc. to be entered in the system After entering data, file to be given to Quality Audit for checking

If any clarification required, send mail to US office.

After checking and corrections, Claims to be transmitted.

After Transmission, Charges completion details to be sent to US office.

If any incorrect details found, Charges department to be informed

QUALITY AUDIT
Quality Audit for Patient Demographics and Charges before sending batch wise update to client

Patient #, Name, Address, SSN, DOB, Home Ph, Work Ph, Guarantor, Subscriber details, Employer, etc to be checked in Patient Demographic File

Date of Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, Place of Service, Type of Service, Referral, Prior Authorization, On bill comments, Location, etc to be checked in Charges File

After Quality Audit, files to be given to Supervisor / Manager for sending Batch Update to client. Log to be updated with patients checked, charges checked, correction details, etc

If any incorrect details found, Charges Team to be informed of the same and correction done

TRANSMISSION Electronic / Paper

After Quality Check is through, List of Electronic Claims to be separated Transmission processes to be accurately followed to avoid rejection Claims to be transmitted electronically through Fast claim, Envoy, Halley, Navicure , Emdeon, Availityetc.

After transmission, log to be updated with patient #, claim#, total claims transmitted, pending claims, etc.

If any incorrect details found, Charges department to be informed

Send mail to Charges department after completion of Transmission

CASH POSTING
Checks and EOB(Explanation of Benefits) to be arranged before doing Cash Posting Insurance Name, Check #, Total Check Value to be cross verified with the Check and EOB Copies

In the EOB Copy, Claim#, Date of Service, Procedure , Units, Charges to be identified before posting

Application of Payment, Deductible, Co-insurance, Adjustments, Write offs, etc in the Cash Posting

After Cash Posting, Claim#, Patient Name and Value to be checked for tallying data with the EOB Log to be updated with Total Checks, Total Value, Posted details, Pending details, etc

If any incorrect details found or any details missing, follow up to be done with Insurance

INSURANCE FOLLOW UP
COVERAGE INFORMATION CONTRACT INFORMATION TREATMENT ELIGIBILITY

CARRIER FEE SCHEDULE

INSURANCE FOLLOW UP

CLAIM STATUS

PROVIDER INFORMATION DENIAL REASONS

PAYMENT DETAILS

INSURANCE ANALYSIS
Claims pending after 30 days Claims denied by Insurance Claims rejected by Insurance Claims not in the Insurance system Claims pending for additional details required

Log to be updated with details of Patient#, Name, Claim#, Value, Insurance, reasons, etc

Analysis and actions to be carried out for resubmitting the claims

AR to follow up with insurance and get the claim status

Claims to be corrected for denials and resent to Carrier

Claims to be corrected for rejections and resent to Carrier

Claims to be printed again and sent to insurance

Information to be faxed or sent through courier to the insurance

PATIENT FOLLOW UP

T N E ION M T T A MA E R T R FO IN

PATIENT
L N NA IO O T S R MA E P OR F IN

E G ON RA T I VE A O M C OR F IN

T N EN T IO YM M A PA R FO IN

PATIENT ANALYSIS
Bills returned due to incorrect address No correspondence from patient Patients giving wrong information

Patient Bills would be sent monthly once and three times to the patient. Log to be updated with details of Patient#, Name, Balance, Bills sent details AR will follow up with the Patient for getting payment from him If Patient does not pay or respond properly even after 90 days, his account would be moved to Collection Agency.

MONTH END REPORTS

Audit Recap

Doctor Financial

Monthend Financial Reports

Patient Financial

Aged AR

Service Analysis Reports

REQUEST FOR INFORMATION

We request to answer the following questions so that we can plan our transition / migration and business process. 1. 2. 3. 4. 5. 6. 7. 8. 9. Volume of Business Current AR Total # of Providers in the Group Payer Mix Software being used Specialty State in which the practice is located MIS Reports of Last Month End and Year End Clearinghouse being used

10. Access to your system for viewing Master Data

Looking forward for a long term association with you.

San Francisco Bay Area 3940 Freedom Circle. Santa Clara, CA -95054 Phone No : 408-200-7468 Los Angeles Area 200 Continental Blvd. El Segundo, CA 90245 TrinityMag Global Services E-74, 1st Floor, Bharat Nagar New Friends Colony, New Delhi-110025 (646) 810 1148 E-mail: query@trinitymag.com